Prescription drug monitoring programs increase racial/ethnic inequities in unmet demand for substance use disorder treatment among people who inject drugs. A repeated cross-sectional analysis of people who inject drugs in 13 states in 2012, 2015, 2018, and 2022.

Abstract

Evidence indicates that prescription drug monitoring programs (PDMPs) reduce demand for substance use disorder (SUD) treatment among the general population, perhaps by minimizing the risk of SUD onset through limiting access to prescribed opioids. Little is known about PDMP effects on SUD treatment among people who inject drugs (PWID), a population at high overdose risk. Using four waves (2012, 2015, 2018, and 2022) of National HIV Behavioral Surveillance (NHBS), we conducted two-way fixed-effect modelling of associations of state-level "mandated review" PDMP policies and individual-level (1) SUD treatment utilization, and (2) unmet demand for SUD treatment among 24,518 PWID in 13 states. We tested effect modification by race/ethnicity. PDMPs were associated with an 8 percentage-point increase in the probability of unmet demand for SUD treatment in the sample as a whole (95% CI: 3.0, 12.0). PDMP implementation was also associated with an increased Black, Indigenous, Latinx, and other people of color (BILPOC) who inject drugs vs. White PWID gap in the probability of unmet demand, from a 3.0 percentage-point gap in non-PDMP states (95% CI: 1.0, 5.0) to a 9 percentage-point gap in PDMP states (95% CI: 7.0, 11.0). PDMPs may increase unmet need for SUD treatment among PWID and amplify racial/ethnic inequities in unmet need. To strengthen PDMP effectiveness, supply reduction policies must be accompanied by enhanced access to SUD treatment and other services for PWID, particularly among BILPOC PWID.